Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 30:13:100279.
doi: 10.1016/j.lanepe.2021.100279. eCollection 2022 Feb.

Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study

Nicholas Kofi Adjei  1 , Daniela K Schlüter  1 , Viviane S Straatmann  2 , Gabriella Melis  1 , Kate M Fleming  1 , Ruth McGovern  3 , Louise M Howard  4 , Eileen Kaner  3 , Ingrid Wolfe  5 , David C Taylor-Robinson  1 ; ORACLE consortium
Affiliations

Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study

Nicholas Kofi Adjei et al. Lancet Reg Health Eur. .

Abstract

Background: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes.

Methods: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders.

Findings: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 - 8·3), cognitive disability (aOR 2·1; CI 1·5 - 2·8), drug experimentation (aOR 2·8; CI 1·8 - 4·2) and obesity (aOR 1·8; CI 1·3 - 2·5).

Interpretation: In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health.

Funding: The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).

Keywords: child health; child poverty; cohort; family adversity; multi-trajectory analysis.

PubMed Disclaimer

Conflict of interest statement

This work was funded by the National Institute for Health Research (NIHR) Policy Research Programme (ORACLE: OveRcoming Adverse ChiLdhood Experiences, Grant reference number NIHR200717); and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. DTR is supported by the NIHR School for Public Health Research, the NIHR Public Health Policy Research and by the Medical Research Council (MRC) on a Clinician Scientist Fellowship (MR/P008577/1). VSS is supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) [2016-07148; 2020-00274]. DKS is supported by the FORTE [2020-00274] and the NIHR Public Health Policy Research Unit. Professors Kaner and Howard are supported by NIHR Senior Investigator awards and Prof Kaner is Director of the NIHR Applied Research Collaboration for the North East and North Cumbria. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, MRC or FORTE. All authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow diagram showing inclusion and exclusion of cohort participant
Figure 2
Figure 2
Estimated trajectory groups of family adversity and poverty in the UK Millennium Cohort Study.
Figure 3
Figure 3
Associations of predicted family adversity and poverty trajectories and child outcomes at age 14 years in the UK Millennium Cohort Study. Models adjusted for child's sex, maternal education, and maternal ethnicity.
See this image and copyright information in PMC

References

    1. Children's Commissioner. Estimating the prevalence of the ‘toxic trio’. 2019. https://www.childrenscommissioner.gov.uk/wp-content/uploads/2018/07/Vuln... (accessed January 1, 2021 ).
    1. Department for EducationThe Stationery Office; London: 2018. Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children.
    1. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. Child Maltreatment 2018.https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2018.pdf (accessed April 1, 2021).
    1. Cleaver H, Unell I, Aldgate J. Children's needs–parenting capacity. Child abuse: Parental mental illness, learning disability, substance misuse and domestic violence London:TSO2011.
    1. Abel KM, Hope H, Swift E, et al. Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. The Lancet Public Health. 2019;4(6):e291–e300. - PMC - PubMed

LinkOut - more resources